The new wave of fiscal conservatives voted into Congress during the 2010 elections are resetting the national agenda, and this rise of “austerity politics” has important implications for health policy, says Jon Oberlander, PhD, professor of health policy and management at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and professor of social medicine in the UNC School of Medicine.

In a perspective published online in the New England Journal of Medicine, Oberlander warns that as the President and Congress deal with significant budget deficits, federal funding of medical care programs, including Medicare and Medicaid, are likely to be targets for cuts.

“As they search for savings, deficit cutters are likely to focus on health programs, whose size makes them an inviting target,” Oberlander writes. “Together, Medicare and Medicaid account for 23 percent of all federal spending, and in Washington, the long-term deficit problem is seen largely as a health care problem.”

Oberlander explains that historically, federal health care policies have changed with economic fluctuations, resulting in a “cycle of crisis and reform,” especially in the Medicare arena. Now, as health care costs rise and the population ages, the prospects of cost controls as a way to address the deficit are more and more likely. These cost concerns can be a positive force in health policy reform, Oberlander said, but he warns that these reforms must be more than just “exercises in cost shifting.” The key is to find ways to reduce health care costs for everyone, and not just shift the burden of payment, he said.